With mother's blessing I can report that things are going 'OK'.
Baby is now 2 months old. Mother has had no psychotic ideation for over 5
weeks at least. She is going for medical/psychiatric monitoring every 2
weeks, and living at home. Father still home full time and helping with child
care as her meds make her a bit sluggish. She is still on valproate,
oxazepam, zopiclone and olanzapin. Goal is to reduce to valproate only, with
oxazepam on those occasions when she can not sleep. She doesn't want to
expose baby to the combination of drugs, and father is even more hesitant
about that. I found info from Norway about similar combinations that supports
very cautious breastfeeding. Baby will take breast in mouth when he is not
too hungry, and in a good mood, and suckles for short times, stopping more
because she takes him off, anxious about the meds. I met him for the first
time today. He is a beaming, smiley boy who enjoys the company of his mother,
and she his.
She is pumping just to keep her milk glands producing, i.e. once daily, and
gets a couple of ounces in no time. I have guaranteed her that her supply
will not diminish with more frequent pumping, but beyond that I will make no
predictions about whether she will ever be his sole nutritional supplier. It
seems that by the time she is off the heavier meds, he may be almost ready for
solids too. I am trying to see the positive side of that - since he will not
be getting all his food from her, she can give her milk before she is entirely
off meds. I have also pointed out that if you can breastfeed fully with low
doses or short-term treatments with these meds (gist of the info I found),
then you can take the higher doses and breastfeed marginally, if only to keep
baby motivated to nurse now and then. Gave her written info to take back
home, and am sending it to the doc who is now treating her. The doc is
sceptical to BF with any meds (we know this song, right?) and needs gentle
updating. I am sending the info along with my notes as soon as I send this
off.
We tried an SNS here today, but baby was too impatient and protested loudly.
She got some info to take home with her, and is encouraged to spend some time
daily skin-to-skin with him, for both their sakes. She can easily express
milk and get things flowing, even with such minimal stimulation.
She is very grateful for the support she has gotten, to preserve her milk
supply. She thanks Lactnet, as do I, for the info I was sent from several of
you, and which has been shared with the ward she was admitted to, where the
staff were very interested in the IBCLC perspective on pp psychosis. I see a
possible in-service in our future...
This mother still feels that her illness is characterized by a super-response
to oxytocin and prolactin. Now that those peaks have settled down it seems
not to affect her adversely. Last time she had a major depression following
the psychotic phase, which for her is quite manic. No sign of any depression
yet. I hope she avoids that, and maybe preserving the BF is helping keep her
mood light and positive, who can say? My personal opinion is that she could
be giving the pumped milk to the baby without concern, as most of his food is
coming from a package of powder. But this is about her goals and criteria,
not mine, drat it!
So: still lactating, not feeding baby her milk, but optimistic because she has
the possibility at some point in the future. Also, pleased that she is
recovering so much more quickly than after her first baby was born, and *very*
pleased with her care. When I asked if I could share some info about her with
Lactnet, she didn't hesitate to say yes, and she doesn't care if anyone can
identify her from this post. 'I have a mental illness that is precipitated by
giving birth,' she says. 'I don't see why that should be some big secret.'
I've been reading all the e-mails to us listmothers as I sit here, about what
Lactnet means to you. Thanks so much. This case is a good example of the key
role a support community can play, so thanks for that too.
Rachel Myr
after a good day's good work in Kristiansand, Norway
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